AboutArthur Goldstein, M.D. Expertise Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations American Medical Association, American Urological Association, American College of Surgeons
Question Hello, my father is 78 years old. He was diagnosed with prostate cancer and had part of his prostate removed, and also started the seed implants. Prior to this surgery he was having reoccuring uti's and after the surgery they felt his bladder hadn't gone back down to normal size. He continues to have uti's, and each time they put him on different types of antibiotics. Most don't seem to help so they yet again put him on something different. He is now hospitalized yet again and is weak, has a uti, no appetite, and a elevated white blood cell count. The doctors aren't telling my mom much of anything. It seems that they cannot find the cause of why he keeps getting these uti's. Please, I'm desperate for any information in which I can ask these doctors. He is at a VA hospital, so I don't even feel right now he is getting proper care as it appears he isn't. They forgot to feed him last night after admitting him and we can't get any specific answers. They did a scan but did not tell my mom what type of scan or for what.
Thank you.
Answer Debbie, the general term urinary tract infection (UTI) does not define where the infection originated. Typical symptoms of a lower UTI (bladder) are frequency, burning, and urgency. With more severe inflammation, blood may appear in the urine. If bleeding occurs, one should seek consultation with a urologist to ensure that there are no other causes for the bleeding. If the infection spreads from the bladder into the kidneys, the patient is much more ill and additionally exhibits flank (kidney) pain, fever and chills. Kidney infections (pyelonephritis) may also come from blockage of kidney drainage such as by stones among many other causes. If untreated, kidney infections may then spread into the blood stream causing a life threatening disorder called septicemia. This requires hospitalization, intravenous antibiotics and intensive care. Most UTIs involve the lower urinary tract (urethra and/or bladder). A tentative diagnosis is made by doing a urinalysis which typically demonstrates white blood cells (“pus cells”) and bacteria. Culturing the urine for bacteria provides a definitive diagnosis. Sensitivity studies are then done on the culture to determine which antibiotics will destroy the germ. Most routine UTIs require 3-7 days of antibacterial therapy. If the infections are frequent, long-term contunuous low dose prophylactic antibacterial therapy may be needed. If one suffers a single kidney infection or multiple lower UTIs, urological investigation of the entire urinary tract is indicated to look for a correctable cause. This involves looking at the kidneys with imaging studies such as IVP (intravenous pyelogram), CT scan, MRI or ultrasound as well as doing a cystoscopic examination of the lower urinary tract. A measurement of residual urine (RU - the urine left behind in the bladder after urinating) should also be measured. If the RU is significantly elevated, it may be difficult to treat the UTI without measures to empty the bladder better. With the above information, you should be able to ask appropriate questions of his urologist and get answers. If still not happy with his care, obtain another opinion. Good luck!
